title: Clinically-driven need for secondary interventions after endovascular revascularization of tibial arteries in patients with critical limb ischemia.
abstract: OBJECTIVE
  To assess the need for clinically-driven secondary revascularization in critical limb ischemia (CLI) patients subsequent to tibial angioplasty during a 2-year follow-up.
  
  
  METHODS
  Between 2008 and 2010, a total of 128 consecutive CLI patients (80 men; mean age 76.5±9.8 years) underwent tibial angioplasty in 139 limbs. Rutherford categories, ankle-brachial index measurements, and lower limb oscillometries were prospectively assessed. All patients were followed at 3, 6, 12 months, and annually thereafter. Rates of death, primary and secondary sustained clinical improvement, target lesion (TLR) and target extremity revascularization (TER), as well as major amputation, were analyzed retrospectively. Primary clinical improvement was defined as improvement in Rutherford category to a level of intermittent claudication without unplanned amputation or TLR.
  
  
  RESULTS
  All-cause mortality was 8.6%, 14.8%, 22.9%, and 29.1% at 3, 6, 12, and 24 months. At the same intervals, rates of primary sustained clinical improvement were 74.5%, 53.0%, 42.7%, and 37.1%; for secondary improvement, the rates were 89.1%, 76.0%, 68.4%, and 65.0%. Clinically-driven TLR rates were 14.6%, 29.1%, 41.6%, 46.2%; the rates for TER were 3.0%, 13.6%, 17.2%, and 27.6% in corresponding intervals, while the rates of major amputation were 1.5%, 5.5%, 10.1%, and 10.1%.
  
  
  CONCLUSIONS
  Clinically-driven TLR is frequently required to maintain favorable functional clinical outcomes in CLI patients following tibial angioplasty. Dedicated technologies addressing tibial arterial restenosis warrant further academic scrutiny.
authors.affiliation: 1 Department of Clinical and Interventional Angiology, Inselspital, University Hospital of Bern, Switzerland.
authors.forename: Frederic
authors.initials: F
authors.lastname: Baumann
authors.forename: Stephan
authors.initials: S
authors.lastname: Bloesch
authors.forename: Rolf Peter
authors.initials: RP
authors.lastname: Engelberger
authors.forename: Vladimir
authors.initials: V
authors.lastname: Makaloski
authors.forename: Hanspeter
authors.initials: H
authors.lastname: Fink
authors.forename: Dai-Do
authors.initials: DD
authors.lastname: Do
authors.forename: Iris
authors.initials: I
authors.lastname: Baumgartner
authors.forename: Nicolas
authors.initials: N
authors.lastname: Diehm
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000800:Angioplasty, Balloon / Q000009:adverse effects* / Q000401:mortality; D016638:Critical Illness; D005260:Female; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016909:Tibial Arteries; D013997:Time Factors; D016896:Treatment Outcome